Although the Choosing Wisely recommendations from the Society of Thoracic Surgeons are against brain imaging in asymptomatic patients with non-small cell lung cancer, wide variation in use among centers suggests a lack of adherence or knowledge about the recommendations, according to an article published online ahead of print in Chest.1

Researchers in this study sought to describe the use of brain imaging and to identify variables associated with it among National Lung Screening Trial (NLST) participants. A total of 643 patients with clinical stage 1 non-small cell lung cancer were identified.

Of those, 12% of patients had received at least one brain imaging study. Of 1.1% of patients who were upstaged to stage 4 disease, two underwent imaging and neither had brain metastasis.

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Researchers found high frequency variation among enrollment centers (0% to 80%). Multivariate analysis revealed that primary tumor size >20 mm (OR, 2.50; 95% CI, 1.50-4.16; P<.001) and age 65 to 69 (OR, 2.78; 95% CI, 1.38-5.57; P<.01) were linked to greater use of imaging.

Researchers concluded that one in eight NLST patients with stage 1A non-small cell lung carcinoma underwent brain imaging, but no proof of intracranial metastases was discovered.


  1. Balekian AA, Fisher JM, Gould MK. Brain imaging for staging of patients with clinical stage IA non-small cell lung cancer in the National Lung Screening Trial: adherence with recommendations from the Choosing Wisely campaign [published online ahead of print September 10, 2015]. Chest. doi: 10.1378/chest.15-1140.